1. BCCO PCT #4 PowerPoint AND HIV/AIDS & Viral Hepatitis In the Criminal Justice Profession TCOLE Course # 3804 UNIT ONE Texas Commission On Law Enforcement and Texas Department of State Health Services

2. ADMINISTRATIVE Please complete the BCCO PCT #4 Registration form and turn it in now. Make sure you sign TCOLE Report of Training (PID#, Full Name and DOB). All cell phones off please – pay attention to course materials and show common respect & courtesy.

3. Your Instructor – Course Facilitator and Mentor Trainer 9/17/20153 Deputy Chief George D. Little A.S. & B.S. Criminal Justice & Sociology B.S.CJ Wayland Baptist University, San Antonio M.S. Criminology & Counter-Terrorism University of the State of New York(P) 2012 T.C.O.L.E. Professional Achievement Award Certified Crime Prevention Specialist (C.C.P.S.) TCOLE Basic Instructor Certificate 1984 TCOLE Advanced Instructor 2012 TCOLE Master Peace Officer 1991 MP Special Operations Operator Counter-Terrorism 1988 Military Police Investigations (MPI) & Criminal Investigation Division (CID) Special Agent Graduate Drug Enforcement Administration Academy 1977 43- years Law Enforcement Experience 39-Years Teaching & Instructor Experience

4. COURSE/LESSON OVERVIEW HIV/AIDS HBVHCV The purpose of this course is to educate individuals on matters pertaining to communicable diseases such as HIV/AIDS, HBV, and HCV which impacts the criminal justice profession.

5. Learning Objectives Learning Objective 1.0 Learning Objective 1.0 : The participant will be able to understand and explain relevant terms and definitions of HIV/AIDS, HBV and HCV Learning Objective 1.1 Learning Objective 1.1 :The participant will be able to write general statements regarding HIV. Learning Objective 1.2 Learning Objective 1.2 :The participant will be able to to list and describe the general stages of HIV infection.

6. Learning Objective 1.3 Learning Objective 1.3 :The participant will be able to write general statements regarding AIDS. Learning Objective 1.4 Learning Objective 1.4 :The participant will be able to describe in writing, the relationship between HIV and AIDS. Learning Objective 1.5 Learning Objective 1.5 :The participant will be able to write general statements regarding Hepatitis A (HAV). Learning Objective 1.6 Learning Objective 1.6 :The participant will be able to write general statements regarding Hepatitis B (HBV). Learning Objectives

7. Learning Objective 1.7 Learning Objective 1.7 :The participant will be able to describe the relationship between acute and chronic HBV infection. Learning Objective 1.8 Learning Objective 1.8 :The participant will be able to write general statements regarding HCV. Learning Objective 1.9 Learning Objective 1.9 :The participant will be able to describe the relationship between acute and chronic HCV infection. Learning Objectives

8. FORWARD The occurrence of communicable diseases has dramatically affected every part of the justice system worldwide; Legal, law enforcement and custody issues. HIV, AIDS, hepatitis, and other sexual transmitted diseases (STDs) are big problems in the judicial system.

9. Acknowledgement This course is developed by the Texas Commission on Law Enforcement (TCOLE) for presentation to any individual associated with or employed by any entity of the criminal justice system.

10. Unit One 1.0Functional Area 1.0Functional Area : This section will introduce the participant to HIV/AIDS, HBV, and HCV. The participant will master an understanding of the relevant terms and definitions of HIV/AIDS, HBV and HCV.

11. Learning Objective 1.1Learning Objective: 1.1Learning Objective: The participant will be able to write general statements regarding HIV.

12. A. What is HIV? Human H = Human Immunodeficiency I = Immunodeficiency Virus V = Virus 1.1 General Statement (HIV)

13. 1.1 General Statement (HIV) Cont’d AIDS B.Virus that causes AIDS HIV C.Once a person is infected, they can immediately transmit HIV to another person

15. fight D.Destroys the body's ability to fight infections and certain cancers by killing or damaging cells of the body's immune system infected E.A person infected may remain without symptoms for a long period of time 1.1 General Statement (HIV) Cont’d

17. HIV HIV F.There is no cure for HIV. Once an individual becomes infected with HIV the person is infected for life. DrugsHIV Drugs to fight both HIV infection and its associated infections and cancers are currently available. 1.1 General Statement (HIV) Cont’d

19. HIV disease HIV G.Increased understanding of HIV disease progression, refinement and acceptance of holistic therapies, availability of sophisticated testing, ability to prevent or reduce the impact of opportunistic infections, and potent treatment therapies have made HIV an increasingly manageable chronic disease. 1.1 General Statement (HIV) Cont’d

20. 20 DEFINE & PROCESS Process: Define 1.1: Define 1.1: Write four out of seven general statements regarding HIV

21. Learning Objective 1.2 Learning Objective: The participant will be able to list and describe the general stages of HIV infection.

22. 1.2 General Stages of HIV Infection. A.stages HIV AIDS A. There are general stages of HIV infection that one may go through before AIDS develops.

23. B. infectionHIV B. Infection. The earliest stage is right after infection with HIV. HIVcells HIV can infect cells and copy itself before the immune system has started to respond. flu Individuals may feel flu -like symptoms during this time. 1.2 General Stages of HIV Infection…Cont’d

25. Infection HIV bloodstream HIV enters the bloodstream and begins to take up residence in the cells. HIV infectious virus People with HIV are considered to be infectious immediately after infection with the virus. 1.2 General Stages of HIV Infection…Cont’d

26. infectivity possibleHIV Although some studies suggest that the level of infectivity varies over time depending on the stage of the disease in which the person is, it is not possible for most HIV -infected people to find out what their level of infectivity is. HIV A person with HIV is infectious at all times. Infection – Cont’d 1.2 General Stages of HIV Infection…Cont’d

27. symptomsHIV Also, a person does not need to have symptoms or look sick to have HIV. HIV In fact, people may look perfectly healthy for many years despite the fact that they have HIV in their bodies. HIV antibody The only way to find out if a person is infected is by taking an HIV antibody test. Infection – Cont’d 1.2 General Stages of HIV Infection…Cont’d

29. C. body C. Response. The next stage is the body responds to the virus. virusantibodies Even if a person doesn’t feel any different, their body is trying to fight the virus by making antibodies against it. seroconversion HIVHIV This is called sero - conversion, when a person goes from being HIV negative to HIV positive. 1.2 General Stages of HIV Infection…Cont’d

30. D. stage D. No symptoms. HIV infected individuals may enter a stage in which they have no symptoms. asymptomatic This is called asymptomatic infection. HIV They still have HIV and it may be causing damage that they can’t feel. 1.2 General Stages of HIV Infection…Cont’d

31. EARLY SIGN

32. E. PCP E. Symptoms. Symptomatic HIV infection is when symptoms are developed, such as certain infections, including PCP. F.AIDS diagnosed single AIDS F. AIDS is diagnosed when you have a variety of symptoms, infections, and specific test results. There is no single test to diagnose AIDS. 1.2 General Stages of HIV Infection…Cont’d

33. Primary HIV infection FACTS HIV HIVdisease Primary HIV infection is the first stage of HIV disease, when the virus first establishes itself in the body. acute HIV infection HIV 612 Some researchers use the term acute HIV infection to describe the period of time between when a person is first infected with HIV and when antibodies against the virus are produced by body (usually 6 - 12 weeks). 1.2 General Stages of HIV Infection…Cont’d

35. 72 post-exposure prevention Within the first 72 hours after exposure, post-exposure prevention (PEP) may be possible. 70% HIVflu- like" symptoms Up to 70% of people newly infected with HIV will experience some " flu- like" symptoms 1.2 General Stages of HIV Infection…Cont’d

36. These symptoms, which usually last no more than a few days, might include: fevers fevers, chills chills, Night sweats Night sweats andrashes not cold-like symptoms (not cold-like symptoms). 1.2 General Stages of HIV Infection…Cont’d

37. mild The remaining percentage of people either do not experience "acute infection," or have symptoms so mild that they may not notice them. otherHIV Given the general character of the symptoms of acute infection, they can easily have causes other than HIV, such as a flu infection. 1.2 General Stages of HIV Infection…Cont’d

38. viralinfection For example, if you had some risk for HIV a few days ago and are now experiencing flu-like symptoms, it might be possible that HIV is responsible for the symptoms, but it is also possible that you have some other viral infection. 1.2 General Stages of HIV Infection…Cont’d

39. HIVvirus During acute HIV infection, the virus makes its way to the lymph nodes, a process which is believed to take three to five days. HIV bloodstream Then HIV actively reproduces and releases new virus particles into the bloodstream. HIV This burst of rapid HIV replication usually lasts about two months. 1.2 General Stages of HIV Infection…Cont’d

40. HIV Scientists disagree about whether anti- HIV treatment is useful during primary HIV infection, and there is little information from clinical trials. HIV antiretroviral Most HIV specialists believe that early highly active antiretroviral therapy (HAART) is useful, and that its benefits likely outweigh the disadvantages of no treatment. 1.2 General Stages of HIV Infection…Cont’d

41. HIV Some doctors are treating newly HIV- infected people with a combination of anti- HIV drugs. HIV drug HIV HIV While many researchers are optimistic about early anti- HIV treatment, they are also concerned about drug side effects, long-term effects and the possibility of developing drug-resistant virus if people use powerful anti- HIV drugs before they become ill due to HIV disease

42. Some researchers think that if HIV replication can be slowed down early in the course of disease, it will take longer before a person develops AIDS

43. HIVdisease are associated with less severe illness Several studies have shown that low blood viral load levels in the early stages of HIV disease are associated with less severe illness and slower disease progression.

44. HIV Some even think that it might be possible to eradicate, or completely kill off HIV, if treatment is started very early. HIV eradication HIV So far, though, complete HIV eradication has not occurred, and most doctors recommend that anti- HIV treatment should be continued indefinitely once it is started.

45. 45 DEFINE & PROCESS Process: Define 1.2: Define 1.2: List and describe general stages of HIV infection.

46. Learning Objective 1.3 1.3 Learning Objective: The student will be able to write general statements regarding AIDS.

47. 1.3What is AIDS? 1.3 What is AIDS? Acquired A = Acquired I Immuno- I = Immuno- D deficiency D = deficiency S Syndrome S = Syndrome

48. 1.3 General Statements (AIDS) A.AIDS A. AIDS is the common abbreviation for Acquired Immunodeficiency Syndrome B.AIDS B. The term AIDS applies to the most advanced stages of HIV infection

50. C.AIDS HIVinfection C. AIDS is the result of the natural progression of HIV infection D. AIDS 1981 D. The acquired immunodeficiency syndrome ( AIDS ) was first recognized in 1981 1.3 General Statements (AIDS) – Cont’d

52. 52 DEFINE & PROCESS Process: Define 1.3: Define 1.3: Write general statements regarding AIDS

53. Learning Objective HIV AIDS 1.4 Learning Objective: The participant will be able to describe in writing, the relationship between HIV and AIDS

54. 1.4 Relationship Between HIV and AIDS A. AIDS HIV A. Individuals don’t transmit AIDS they transmit HIV. B.HIVinfections opportunistic infections B. As a result of HIV, infections that are allowed because of the immune system breakdown are called “opportunistic infections.” These infections generally do not affect healthy people.

55. C. AIDSHIV 200 HIV C. The definition or diagnosis of AIDS includes all HIV -infected people who have fewer than 200 CD4+ T cells per cubic millimeter of blood. (Healthy adults usually have CD4+ T-cell counts of 1,000 or more.) Or a diagnosis of two or more of 26 clinical conditions that affect people with advanced HIV disease. 1.4 Relationship Between HIV and AIDS – Cont’d

56. D. HIV D. Common opportunistic infections associated with HIV are: Pneumocystiscarinii pneumoniaPCP 1. Pneumocystis carinii pneumonia ( PCP ) KaposisKS 2. Kaposis Sarcoma ( KS ) TuberculosisTB 3. Tuberculosis ( TB ) 1.4 Relationship Between HIV and AIDS – Cont’d

58. E.HIV differently E. HIV infection progresses in each individual differently ; individual immune systems, health behaviors, resources, and chance all contribute to the course of infection. 1.4 Relationship Between HIV and AIDS – Cont’d

59. F.HIV F. How would I know if I have HIV ? tested 1. The only sure way to know your status is to be tested antibody 2. The most common test is an antibody test infection 3. The antibody test (EIA) detects infection in most persons within 6 weeks to 3 months 1.4 Relationship Between HIV and AIDS – Cont’d

61. F. HIV F. How would I know if I have HIV? Western 4. Any positive antibody test must be confirmed with a second type of test, the Western Blot positive HIV 5. Both tests (EIA and Western Blot) must be positive for someone to be told s/he has HIV 1.4 Relationship Between HIV and AIDS – Cont’d

63. Split Decision

64. Split Decision Video HIV Split Decision intends to open the lines of communication in relationships as it relates to the rapidly spreading HIV virus. This is a five minute short film of a longer piece of work directed by Sanedria Arne’ Porter, writer/director originally from Winston-Salem, N.C. currently

65. residing in Atlanta, Georgia. This short film was written by Sanedria Arne' Potter & Kirk A. Moore. VIDEO NOT ASVAILABLE

66. 66 DEFINE & PROCESS Process: Define 1.4: Define 1.4: Describe in writing the relationship between HIV and AIDS.

67. Learning Objective 1.5 1.5 Learning Objective: The participant will be able to write general statements regarding Hepatitis A (HAV).

68. 1.5 General Statements Regarding Hepatitis A (HAV) A.Hepatitis A. Hepatitis is a disease that causes inflammation of the liver B.liver filter for poisons B. The liver is an organ that helps your body digest food and acts as a filter for poisons or anything toxic in the body

70. C.liver C. The liver is it located in the upper right quadrant of the abdomen, tucked up under your rib cage. D.Hepatitis AHAVliver Hepatitis A virus D. Hepatitis A ( HAV ) is a liver disease caused by the Hepatitis A virus 1.5 General Statements Regarding Hepatitis A (HAV) – Cont’d

73. E. 1/3 HAV E. 1/3 of Americans have evidence of past HAV infection F. stoolfeces HAV F. It is found in the stool (feces) or persons infected with HAV 1.5 General Statements Regarding Hepatitis A (HAV) – Cont’d

75. G. feces HAV G. It is usually spread when a person eats food or drinks water that has been contaminated with the feces of someone with HAV H. gloves H. It is important to wear gloves when handling inmate linen or clothing 1.5 General Statements Regarding Hepatitis A (HAV) – Cont’d

77. I.HAV I. Signs & Symptoms of HAV : symptoms 1. Persons may not have any symptoms (older persons are more likely to have symptoms than children). 1.5 General Statements Regarding Hepatitis A (HAV) – Cont’d

79. I.HAV I. Signs & Symptoms of HAV : 2. If symptoms are present, they usually occur quickly and may include fever, tiredness, and loss of appetite, nausea, abdominal discomfort jaundice and dark urine fever, tiredness, and loss of appetite, nausea, abdominal discomfort, jaundice and dark urine 1.5 General Statements Regarding Hepatitis A (HAV) – Cont’d

80. I.HAV I. Signs & Symptoms of HAV : 28 3. The average incubation time from exposure to symptoms is 28 days (15-50 days) 2 4. Symptoms usually last less than 2 months 1.5 General Statements Regarding Hepatitis A (HAV) – Cont’d

82. 1.5 Signs and Symptoms Long Term Effects of HAV infection There is no chronic (long-term) infection hepatitis A cannot One you have had hepatitis A, you cannot get it again vaccine There is a vaccine for hepatitis

84. 14 If you have been exposed, Immune globulin can be given to prevent infection (within 14 days of exposure) 15% HAV About 15% of people infected with HAV will have prolonged or relapsing symptoms over a 6-9 month period 1.5 Signs and Symptoms Long Term Effects of HAV

86. SYMPTOMS Review If symptoms are present, they usually occur quickly and may include: Fever Nausea Tiredness Loss of appetite Abdominal Discomfort Jaundice Dark urine

87. Jaundice

88. 88 DEFINE & PROCESS Process: Define 1.5: Define 1.5: Write general statements regarding Hepatitis A (HAV)

89. Learning Objective 1.6 Learning Objective: The student will be able to write general statements regarding Hepatitis B (HBV).

91. 1.6 general statements regarding Hepatitis B (HBV) A. HBV hepatitis B A. HBV is the common abbreviation for hepatitis B virus. B.Hepatitis B liver hepatitis B B. Hepatitis B is an inflammation of the liver caused by infection with the hepatitis B virus

92. C.HBV chronicstages C. HBV has both acute (new, short- term) and chronic stages (ongoing, long-term). D. severity of the disease fatal D. The severity of the disease can range from mild or unapparent to severe or even fatal. 1.6 general statements regarding Hepatitis B (HBV) – Cont’d

93. E.Hepatitis B vaccination adolescents HBV HBV E. Hepatitis B vaccination is recommended for all unvaccinated adolescents, all unvaccinated adults at risk for HBV infection, and all adults seeking protection from HBV infection. 1.6 general statements regarding Hepatitis B (HBV) – Cont’d

94. F. Transmission F. Transmission: fluids blood 1. Contacting blood/body fluids containing blood if you are not immune (via vaccine/ prior infection) infected person 2. Having sex with an infected person without using a condom needles 3. Sharing needles to inject drugs or “works” (spoons, cotton, water) 1.6 general statements regarding Hepatitis B (HBV) – Cont’d

96. G. Symptoms G. Symptoms: Jaundice 1. Jaundice (eyes and/or skin), loss of appetite, nausea, vomiting, fever, stomach or joint pain and fatigue lasting weeks or months 4 2. The average incubation period (from exposure to symptoms) is approximately 4 months 1.6 general statements regarding Hepatitis B (HBV) – Cont’d

99. Review What is Hepatitis B? Hepatitis B is an inflammation of the liver caused by infection with the hepatitis B virus (HBV) Hepatitis B is spread through contact with infected blood (usually through sex or sharing needles/works) HBV has both acute (new, short-term) and chronic stages (ongoing, long-term) The severity of the disease can range from mild or unapparent to severe or even fatal

100. You should have these in your patrol kit/bag

101. 101 DEFINE & PROCESS Process: Define 1.6: Define 1.6: Write general statements regarding Hepatitis B (HBV)

102. Learning Objective 1.7 Learning Objective: The student will be able to describe the relationship between acute and chronic HBV infection.

103. 1.7 the relationship between acute and chronic HBV infection. A. hepatitis B shortly A. Acute hepatitis B occurs shortly after exposure to the virus. B.hepatitis B HBV 6 B. Chronic hepatitis B is an infection with HBV that lasts longer than 6 months. Once the infection becomes chronic, it may never go away completely.

104. C. 95% C. About 95% of people who are infected are able to fight off the virus so their infection never becomes chronic. D. hepatitis B chronichepatitis B D. The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B. 1.7 the relationship between acute and chronic HBV infection…Cont’d

105. Relationship between Acute & Chronic HBV Acute hepatitis B occurs shortly after exposure to the virus Chronic hepatitis B is an infection that lasts longer than 6 months About 85% of people who are infected are able to fight off the virus so their infection never becomes chronic The younger you are when you become infected with the hepatitis B virus, the more likely you are to develop chronic hepatitis B 1.7 the relationship between acute and chronic HBV infection…Cont’d

106. The Hepatitis B vaccine is the best protection against HBV Immune globulin can be given within 7 days if you are exposed to HBV and not vaccinated. You should also be given the first dose of HBV vaccine Three doses are needed for complete protection (0, 1-2, 4-6 months) 1.7 the relationship between acute and chronic HBV infection…Cont’d 1.7 the relationship between acute and chronic HBV infection.

107. 1.7 HBV Vaccine Most young adults and children have been vaccinated against HBV by the age of 2 (or 12- 18 years of age if not vaccinated as a child) The CDC, the National Commission on Correctional Health Care and the Society of Correctional Physicians recommend that correctional officers and correctional health care workers be vaccinated against HBV 1.7 the relationship between acute and chronic HBV infection…Cont’d

108. 108 DEFINE & PROCESS Process: Define 1.7: Define 1.7: Describe the relationship between acute and chronic HBV infection

109. Learning Objective 1.8 Learning Objective: The student will be able to write general statements regarding Hepatitis C (HCV).

110. 1.8 General Statements regarding HCV A.HCV hepatitis C A. HCV is the common abbreviation for hepatitis C virus. B.Hepatitis C liver hepatitis C B. Hepatitis C is an inflammation of the liver caused by infection with the hepatitis C virus.

112. C. HCV blood C. HCV is the most common chronic blood borne viral infection in the United States. D.HCV liver D. HCV is the #1 cause of chronic liver disease and liver transplants. 1.8 General Statements regarding HCV…Cont’d

113. E.HCVacute chronic E. HCV has both acute and chronic stages. F. hepatitis C F. There is no vaccine to prevent hepatitis C. 1.8 General Statements regarding HCV…Cont’d

115. G.Symptoms G. Symptoms : HCV symptoms 1. Most persons with HCV do not have symptoms sick 2. Many persons with chronic HCV have mild to moderate liver damage but do not feel sick 1.8 General Statements regarding HCV…Cont’d

116. G. G. Symptoms – Cont’d: jaundice 3. Some people with an acute infection will have jaundice (skin and/or eyes) or mild flu-like symptoms HCV liver 4. Most people with chronic HCV will only have mild to moderate liver disease 1.8 General Statements regarding HCV…Cont’d

118. G. G. Symptoms – Cont’d: jaundice 5. Symptoms may include jaundice, fatigue fatigue, appetite loss of appetite andnausea 1.8 General Statements regarding HCV…Cont’d

120. 120 DEFINE & PROCESS Process: Define 1.8: Define 1.8: Write general statements regarding HCV

121. Learning Objective 1.9 Learning Objective: The student will be able to describe the relationship between acute and chronic HCV infection.

122. 1.9 relationship between acute and chronic HCV infection A. unaware they’re infected A. Most persons with acute infection experience few, if any, symptoms and are unaware they’re infected. B.treatment C B. There is no treatment for acute hepatitis C.

124. C. HCV clear C. Out of 100 persons infected with HCV, approximately 15-25 will spontaneously clear the virus without treatment. The other 75-85 go on to develop chronic infection. 1.9 relationship between acute and chronic HCV infection…Cont’d

126. D.HCV donor D. Over time HCV may cause your liver to stop working and a new liver from a donor may be needed. E.medicines hepatitis C E. Antiviral medicines for chronic hepatitis C are available. 1.9 relationship between acute and chronic HCV infection…Cont’d

128. Natural History of HCV Infection 100 People Resolve (15) 15% Chronic (85) 85% Cirrhosis (17) Stable (68) 80% 75% Stable (13) Mortality (4) 25% Time 20% Leading Indication for Liver Transplant

129. BloodBorne Pathogens for Law Enforcement (Length: 19 minutes) This video is strictly for visual aid and is not required to teach this course. It is a good tool that can help gain a better understanding of the material. If your agency is a member of the Texas Municipal League Intergovernmental Risk Pool (TML), you can contact them at 1-800-537-6655 to acquire this video. If your agency is a member of the Texas Association of Counties (TAC), you can contact them at 1-800-456- 5974.

130. 130 DEFINE & PROCESS Process: Define 1.9: Define 1.9: Describe the relationship between acute and chronic HCV infection.

131. Questions?

132. 132 DEFINE & PROCESS Process: REFER TO YOUR PARTICIPANT HANDOUT…. REFER TO YOUR PARTICIPANT HANDOUT…. Define 7.0: Define 7.0: Explain the key points – elements for Human Trafficking Investigation

133. SOURCES All Course Sources and/or Resources are listed in your Participant Handout HIV-AIDS & Viral Hepatitis in CJ Profession TCOLE Course # 3271 Bexar County Constable Office PCT#4

134. “Knowledge is “POWER” Stay informed, stay SAFE, stay Vigilant & stay Alive”

135. TAKE A 15-MINUTE BREAK